November 28, 2017
In a blog on the O’Neill Institute website, Drew Aiken writes that we are addressing tuberculosis (TB), one of the most ancient diseases, with approaches nearly as ancient. This includes over-hospitalization, use of involuntary isolation, and in some countries, use of discriminatory and punitive laws which violate human rights and impede the fight against TB.
In a blog on the O’Neill Institute website, Drew Aiken writes that we are addressing tuberculosis (TB), one of the most ancient diseases, with approaches nearly as ancient. This includes over-hospitalization, use of involuntary isolation, and in some countries, use of discriminatory and punitive laws which violate human rights and impede the fight against TB.
One of the issues identified is that the newer TB medicines for drug-resistant strains are generally unavailable to those who need them most. Only 5% of people in need have access to these more effective medicines. This means that people have no choice but to take older, more toxic drugs which cause deafness and psychosis and only cure 50% of people who take them.
Isolation, detention and quarantine
Another problem raised in the blog is that in some countries, public health laws, criminal laws, and treatment protocols lack a human rights-based, participatory and patient-centered approach.
Drew Aiken: “For example, several countries have public health or other laws which criminalise or broadly allow for isolation, detention and quarantine in the context of infectious diseases including TB. Criminal laws may be for ‘exposure’ or similar offenses. In extreme cases, patients have been imprisoned for inability to adhere to TB treatment. Even when not TB-specific, such provisions may confer wide legal authority on health workers to involuntarily detain TB patients for long periods. Even when not enforced, provisions of this nature further stigmatise people with TB and tend to have the effect of driving people with TB and key populations underground and away from health facilities.”
Aiken concludes that use of involuntary isolation and coercive treatment raises serious ethical and human rights issues. “Improving access to effective and quality community-based treatment, care and support and moving away from coercive and punitive approaches to TB are essential steps to modernise TB care, safeguard medical ethics and human rights, and most certainly to end TB by 2030.”